高压氧综合治疗中、重度颅脑外伤68例

INTRODUCTION Neurotrophic drugs,resting treatment,and proper physical therapy are generally suggested for rehabilitation after head trauma.In recent years,hyperbaric oxygen a new,safe and effective therapy had been used for rehabilitation following head trauma,which is safe,and effective.     

高压氧、纳络酮治疗重型脑外伤

Background:Secondary head injury following severe head trauma is a main factor affecting prognosis,treatment for which is an effective measure in improving prognosis.It is indicated that hyperbaric oxygen can facilitate recovery of injured nerve cells.     

高压氧治疗脑外伤失语症60例疗效观察

目的观察高压氧(HBO)治疗脑外伤后失语症的治疗效果。方法将120例脑外伤患者随机分为HBO治疗组和常规组,常规组治疗采用临床常规治疗,HBO治疗组在常规治疗的基础上实施30次以上HBO治疗。在治疗前后分别用中国康复中心失语症检查法对语言功能进行评估和比较。结果 HBO治疗组和常规组显效率分别为63.3%、13.3%,HBO治疗组和常规组总有效率分别为93.3%、46.7%,差异有统计学意义(P0.05)。结论 HBO治疗脑外伤后失语疗效明显优于常规治疗组,能显著提高疗效。     

高压氧对重型颅脑损伤大鼠血浆内皮素含量的影响

目的:研究高压氧对重型颅脑损伤小鼠血浆内皮素的变化的影响。方法:将100只健康Wistar大鼠按随机数字表法分为创伤对照组和1次/d高压氧疗组,利用自由落体原理制成重型颅脑损伤模型,观测伤后1次/d高压氧治疗后8,24,48,72,96h血浆内皮素含量变化。结果:高压氧治疗组血浆内皮素含量:大鼠伤后8,24,48,72,96h为(199.84±20.34),(200.38±21.17),(203.12±19.11),(206.81±21.54),(211.24±23.57)ng/L较同期对照组犤(231.32±17.18),(234.03±18.24),(240.39±16.37),(254.32±17.25),(268.91±36.65)ng/L犦显著降低(t=3.72～5.46,P<0.01)。结论:重型颅脑损伤后血浆内皮素活性升高,高压氧治疗通过纠正脑缺氧,在一定程度上抑制了内皮细胞产生、释放内皮素,从而减轻了脑水肿和血管痉挛避免了脑继发性损害。     

高压氧联合标准外伤大骨瓣减压手术治疗重型颅脑损伤临床分析

目的探讨高压氧联合标准外伤大骨瓣减压手术治疗重型颅脑损伤的疗效。方法 80例需要开颅手术救治的重型颅脑损伤(GCS≤8分)患者,随机分为两组。常规治疗组40例,仅采用标准外伤大骨瓣减压手术及常规治疗。联合治疗组40例,采用标准外伤大骨瓣减压手术、常规治疗并联合应用高压氧治疗。观察、记录两组治疗后的格拉斯哥昏迷量表(GCS)评分及治疗后3个月格拉斯哥预后量表(GOS)评分。结果联合治疗组治疗后的GCS评分、恢复期的GOS评分均明显高于常规治疗组(P<0.05)。结论高压氧同时联合标准外伤大骨瓣减压手术治疗,能够显著提高重型颅脑损伤的治疗效果,改善患者的预后。     

高压氧治疗一氧化碳中毒68例护理体会

一氧化碳中毒是临床常见急症,其预后与患者吸入一氧化碳时间长短、有无原发疾病有关,并与现场急救及临床治疗护理处置是否妥当有密切关系,我科对68例一氧化碳中毒患者在综合治疗基础上早期进行高压氧治疗,取得较好临床效果.现报告如下.     

高压氧治疗脑外伤病人的效果观察

高压氧治疗是指周期性呼吸超过一个大气压纯氧的治疗.高压氧可提高血氧含量和血氧弥散度,从而改善脑组织的缺氧,使脑组织氧分压相应提高,同时高压氧又可使脑组织线粒体中H+-ATP酶活性增加,从而促进脑组织的修复[1].     

高压氧综合治疗肢体创伤疗效观察

目的 观察高压氧（ＨＢＯ）治疗交通事故造成肢体创作的康复治疗效果。方法 对交通事故造成的４８６例肢体创作（骨折、断指创作后植皮、皮瓣转移）加用ＨＢ 常规治疗的２５６例作为对照。测定ＨＢＯ治疗前后患者血浆中的中分子物质含量。并进行了小鼠创口ＨＢＯ治疗愈合的实验。结果 ＨＢＯ治疗组在肢体创作后骨折愈合、并进行了小鼠创品ＢＨＯ治疗愈合的实验。结果 ＨＢＯ治疗前后患者血浆中的中分子物质含量。并进行了小鼠创     

高压氧治疗重型颅脑损伤患者的疗效观察及护理

目的：探讨高压氧治疗重型颅脑损伤患者的疗效及护理措施。方法：将160例重型颅脑损伤的患者随机分为对照组和高压氧治疗组各80例。对照组按常规治疗,高压氧组在常规治疗的基础上加高压氧综合治疗,高压氧治疗时做好进舱前、舱内和出舱后的护理,指导患者正确吸氧,配合功能锻炼。比较两组患者的有效率及住院时间。结果：高压氧组治疗有效率高于对照组（P＆lt;0.05）,住院时间短于对照组（P＆lt;0.01）。结论：重型颅脑损伤患者配合高压氧治疗可提高治愈率,缩短住院时间。     

颅脑损伤患者高压氧治疗的护理

目的:针对颅脑损伤患者在高压氧治疗中的护理问题,探讨护理措施,完善护理方法,提高患者的治疗安全。方法:对我科35例行高压氧治疗的患者在治疗中出现的护理问题进行探讨,通过治疗前对患者护理评估、心理护理、治疗前准备以及治疗后的观察,指导患者应对不良反应并加强饮食护理等措施。结果:通过系统、有效的护理,本组患者无1例发生并发症,取得较好的效果,提高了治疗安全。结论:为提高高压氧治疗在颅脑损伤患者中的应用,减少不良反应和并发症的发生,实施综合护理是必要的。     

容量复苏对早期严重创伤性休克患者血流动力学和氧输送的影响

目的 探讨大容量复苏对早期严重创伤性休克患者血流动力学和氧输送的影响.方法 监测24例严重腹部创伤患者不同容量复苏时的血流动力学和氧代谢指标.结果 容量复苏收缩压从80～90mm Hg(1 mm Hg=0.133 kPa)上升到100～120 mm Hg时,平均复苏容量分别为(2286±521)ml(1 h)和(3486±758)ml(2 h).心脏指数(CI)从(2.0±0.5)L/(min·m2)上升为(3.2±0.6)L/(min·m2)(P<0.05),体循环阻力指数(SVRI)从(1857.6±750.2)dyn·s/(cm5·m2)上升为(3741.5±862.1)dyn·s/(cm5·m2)(P<0.05),与之相对应,氧输送指数(DO2)从(301.1±74.1)ml/(min·m2)升为(554.1±80.0)ml/(min·m2)(P<0.05),氧耗指数(VO2)为(99.7±51.4)ml/(min·m2)升为(147.2±60.1)mL/(min·m2)(P<0.05),氧摄取指数(O2ext)为(33.1±9.1)%下降至(26.6±8.0)%(P<0.05).结论 在急诊抢救中,早期大容量复苏能改善血流动力学和氧代谢.     

高压氧对重型颅脑损伤术后患者长期预后的影响

目的:探讨高压氧(HBO)对重型颅脑损伤开颅术后疗效及预后的影响。方法:重型颅脑损伤后行标准外伤大骨瓣开颅术后患者97例,术后接受HBO治疗3个月,按是否坚持完成HBO治疗分为完成组61例和未完成组36例。随访5年,观察2组并发癫痫的比率、癫痫发作周期、死亡人数、格拉斯哥昏迷量表(GCS)及生存质量指数(QLI)评分。结果:2组术后24h及术后3个月GCS评分均明显高于术前(P<0.05),术后3个月完成组GCS及QLI评分明显高于未完成组(P<0.05),完成组出现继发癫痫及死亡例数明显低于未完成组(P<0.05);癫痫患者发作周期明显长于未完成组(P<0.05)。结论:重型颅脑损伤患者行标准外伤大骨瓣开颅术后配合标准疗程的HBO治疗可明显降低继发癫痫的比率,提高生存质量。     

高压氧治疗慢性肝炎40例临床疗效分析

目的：观察高压氧治疗对慢性肝炎患者肝脏血流、肝功能的影响。方法：用纯氧单仓治疗４０例慢性肝炎,治疗前、后用肝血流图仪和多普勒Ｂ超测定患者的肝血流图收缩波和门静脉右支血流量,并抽血查肝功能。结果：治疗后患者的肝血流图收缩波和门静脉右支血流量明显升高;肝功能明显改善（Ｐ〈０．０５）。结论：高压氧治疗慢性肝炎可增加患者的肝动脉及门静脉右支血流量,并改善肝功能。     

Pharmacokinetics of high-dose pentobarbital in severe head trauma

High-dose pentobarbital infusion has been advocated as an effective adjunct in controlling persistent intracranial hypertension after severe head trauma in patients refractory to conventional therapy. Pentobarbital disposition was assessed in 10 adults with severe nonpenetrating head injury after an intravenous loading dose of sodium pentobarbital, 10 mg/kg, infused over 1 hour, followed by a continuous infusion at 0.5 to 3.0 mg/kg/hr provided the cerebral perfusion pressure remained greater than 50 torr. Pharmacokinetic parameters of volume of distribution at steady state (Vss), total body clearance (CL), and t1/2 for the patients with trauma were statistically compared with similar estimates reported for seven adult subjects without head injury. On discontinuation of the pentobarbital infusion, serum concentrations in the patients followed a monoexponential decline with a mean (+/- SD) t1/2 and Vss that were significantly less than values reported for the control subjects (15.6 +/- 3.9 vs. 22.3 +/- 4.0 hours and 44.0 +/- 11.7 vs. 63.4 +/- 15.2 L, respectively). However, there was no significant difference between the mean pentobarbital CL of the patients (2.0 +/- 0.7 L/hr) and the subjects (2.0 +/- 0.4 L/hr). To our knowledge this is the first report on the disposition, elimination, and intrasubject variability of high-dose pentobarbital infusion in adult patients with head trauma.     

Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma

OBJECTIVE: To asses the yield and contribution of a routine predetermined repeat head computed tomographic (CT) scan within 24-36 hrs in pediatric patients with moderate to severe head trauma. DESIGN: Records review. SETTING: Five pediatric intensive care units. PATIENTS: We reviewed the charts of 173 consecutive pediatric patients with moderate to severe head trauma (Glasgow Coma Scale score of < or = 11) that survived the first 24 hrs after being admitted to five Israeli trauma centers. Clinical data collected included status at admission, at the time between the first and second CT scans, and after the second scan. Head details of the first, second, and, if performed, third CT scan were collected. Treatment strategy during each period was recorded, including any change in treatment after each CT scan. MEASUREMENTS AND MAIN RESULTS: A total of 47 (27%) of the second CT scans showed new lesions including six intracranial hemorrhages, 17 cases of worsening brain edema, and 18 newly diagnosed brain contusions. However, none of these findings necessitated surgical intervention or any change in therapy. Of the 67 patients who underwent a third CT scan, two cases required surgical intervention because of new findings in the third CT. CONCLUSIONS: A second routine prescheduled head CT scan within 24-36 hrs after admission in pediatric patients with moderate to severe head trauma is unlikely to yield any change in therapy. Clinically and intracranial pressure-oriented CT scan may better select and diagnose patients who require changes in therapy, including surgery. Studies aimed to determine the ideal timing for the second are warranted.     

高压氧治疗颅脑损伤96例临床分析

目的：探讨高压氧治疗颅脑损伤的时机和疗效关系。方法：将９６例各型颅脑损伤患者接受高压氧治疗（除常规治疗外）的不同时机分为３组：Ａ：伤后１～５ｄ;Ｂ：伤后６～１０ｄ;Ｃ：伤后１０ｄ以上。结果：３组的治愈率分别为：Ａ：９７％,Ｂ：８７％,Ｃ：７０％。结论：早期应用高压氧治疗颅脑损伤,治愈率高;致残率低;苏醒快;语言和肢体功能恢复良好。     

依达拉奉治疗急性重型颅脑损伤的疗效观察

目的观察依达拉奉对急性重型颅脑损伤患者的治疗效果。方法将86例重型颅脑损伤患者（GCS≤8分）随机分为治疗组和对照组。治疗组44例,在常规治疗的基础上加用依达拉奉治疗,对照组42例,给予常规治疗。观察并记录两组患者治疗后第7、14、21天的格拉斯哥昏迷评分（GCS）评分及治疗后3个月时的格拉斯哥预后评分（GOS）。结果两组患者治疗7、14、21 d后GCS评分比较差异均有统计学意义（P〈0.05）;3个月后恢复良好率治疗组（57.14%）明显高于对照组（31.43%）;两组的不良反应比较差异无统计学意义（P〉0.05）。结论依达拉奉有助于缩短急性重型颅脑损伤患者昏迷期,能促进患者神经功能恢复。